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Acne Treatment and Therapeutic Strategies
One of the most common skin diseases
Considerable psychological impact onthe quality of life
No cure, but the disease can becontrolled through medications
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Acne Treatment and Therapeutic Strategies
Four important factors
plugging of the hair follicle
hyperactivity of the sebaceous gland
proliferation of Propiono bacterium Acnes
inflammation
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Acne Treatment and Therapeutic Strategies
Stages of Development
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Acne Treatment and Therapeutic Strategies
Inflammatory Lesions
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Acne Treatment and Therapeutic Strategies
Nodulocystic Lesions
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Acne Treatment and Therapeutic Strategies
Scarring
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Acne Treatment and Therapeutic Strategies
Topical Therapy (Indications)
comedonal acne
mild to moderate inflammatory acne
Management
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Acne Treatment and Therapeutic Strategies
Topical Therapy (Treatment Vehicle)cream sensitive or dry skin
lotion any skin type
gel oily skin
solution oily skin
Management
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Acne Treatment and Therapeutic Strategies
Topical Therapy(Anti Comedonal Agents)
Topical Retinoids
Azelaic acid
Salicylic acid
Management
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Retonoic acid
Also known as tretinoic acid /all
transretinoic acid
Epithelial effects; stabilises lysosomes,
ribonucleic acid polymerase activity, PG
E , cAMP levels, incorporation of
thymidine into DNA Its decreases cohesion fo epidremal cells
increases epidremal turnover (Rx effect)
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Acne Treatment and Therapeutic Strategies
Topical Retinoids 0.025% - 0.1%(side effects)
pustular flare due to exposure of previou
non evident comedones
photosensitivity
skin irritation and erythema
dryness and peelingoptimal improvement 8-12weeks
In animals tumerogenenesis of UV light
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Azelaic Acid
Effective for acne vulgaris
MOA ? Antibacterial to P acnes and in vitro
conversion of testosterone to dihydrosterone
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Acne Treatment and Therapeutic Strategies
Azelaic Acid 20%(application and side effects)
applied twice daily, intially OD
for 1 wk
erythema and irritation
decrease in pigmentation
Management
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Salicylic acid
Keratolytic at 3- 6 % > 6% destructive
MOA; ? Desquamation of keratotic cells
If absobed and serum levels are > 30-
50mg/dl salicylism occurs Rx dialysis
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Acne Treatment and Therapeutic Strategies
Salicyl ic Acid0.5 - 2%
(application and side effects)
applied twice daily
skin dryness and irritation.
Utricaria, erythema multiformeCare in diabetics or peropheral
vascular disease
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Acne Treatment and Therapeutic Strategies
Topical Therapy (Anti I nf lammatory Agents)
Benzoyl Peroxide
Management
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Acne Treatment and Therapeutic Strategies
Benzoyl Peroxide 2.5 - 10%(application and side effects)
apply once to twice daily
always apply test dose
avoid use at night
dryness of skin
Management
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Acne Treatment and Therapeutic Strategies
Combination therapy
5% Benzoyl Peroxide and 3% Erythromycin
5% Benzoyl Peroxide and 1% Clindamycin
Topical antibiotics and Azelaic acid or Tretinion
Management
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Acne Treatment and Therapeutic Strategies
Systemic therapy
Oral Antibiotics
Isotretinoin
Hormonal Therapy
Management
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Acne Treatment and Therapeutic Strategies
Oral Antibiotics(used for 3-6 months)Tetracycline 500mg X BD
Doxycycline 100mg X BD
Minocycline 100mg X OD
Eythromycin 500mg X BD
combined with topical therapy
Management
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Acne Treatment and Therapeutic Strategies
I sotretinoin (Accutane) indicated in
severe nodulocystic acne
non responsive acne
severe psychological distressOnly to be used by physicians with
exper ience in the therapy of severe
dermatological disorders
Management
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Acne Treatment and Therapeutic Strategies
I sotretnoin (RoAccutane) side effectsteratogenic
mucosal dryness
photosensitivityarthralgias
alteration of liver enzymes
hypertriglyceridemia and hypercholesterolemia
Management
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Acne Treatment and Therapeutic Strategies
Hormonal Therapy indicated in
acne associated with hirsutism,
menstrual irregularity and alopecia
women desiring contraception
Management
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Acne Treatment and Therapeutic Strategies
Hormonal TherapyOral contraceptives containing low
androgenic progesterone
Cyproterone Acetate
Spironolactone
Management
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